Silent Violence

Global Health, Malaria, and Child Survival in Tanzania

Vinay R. Kamat

Publication Year: 2013

Silent Violence engages the harsh reality of malaria and its effects on marginalized communities in Tanzania. Vinay R. Kamat presents an ethnographic analysis of the shifting global discourses and practices surrounding malaria control and their impact on the people of Tanzania, especially mothers of children sickened by malaria.

Malaria control, according to Kamat, has become increasingly medicalized, a trend that overemphasizes biomedical and pharmaceutical interventions while neglecting the social, political, and economic conditions he maintains are central to Africa’s malaria problem. Kamat offers recent findings on global health governance, neoliberal economic and health policies, and their impact on local communities.

Seeking to link wider social, economic, and political forces to local experiences of sickness and suffering, Kamat analyzes the lived experiences and practices of people most seriously affected by malaria—infants and children. The persistence of childhood malaria is a form of structural violence, he contends, and the resultant social suffering in poor communities is closely tied to social inequalities.

Silent Violence illustrates the evolving nature of local responses to the global discourse on malaria control. It advocates for the close study of disease treatment in poor communities as an integral component of global health funding. This ethnography combines a decade of fieldwork with critical review and a rare anthropological perspective on the limitations of the bureaucratic, technological, institutional, medical, and political practices that currently determine malaria interventions in Africa.

Cover

Title Page, Copyright, Dedication

Contents

List of Illustrations

Preface

Malaria is a complex mosquito-borne parasitic disease. It has an equally
complex social history that is inextricably linked with poverty and structural
inequality. The book’s title “Silent Violence” is derived from Randall
Packard’s The Making of a Tropical Disease (2007) in which he demonstrates
how the history of malaria is closely tied to chronic poverty, ...

Acknowledgments

This book is a culmination of more than a decade of research and writing
on malaria in Tanzania. It is also a partial record of how Tanzania’s
malaria program has unfolded over a decade, its pivotal moments, and the
direction in which it is headed. In the summer of 1998, CARE Tanzania
offered me my first opportunity to travel to Africa as a consultant on a
malaria project. ...

Part I: Global Discourses

1. The Violence of a Global Killer

One early morning in February 2001, the head nurse at the village dispensary
and a young woman with a very sick child tied around her waist with a
kanga, were engaged in a loud verbal battle on the dispensary’s verandah.
They were calling each other names and making insulting references to
each other’s kabila or ethnic identity. ...

2. Locating the Field

Mainland Tanzania is administratively divided into twenty-six regions
(mkoa), and each region is further divided into districts (wilaya) and wards
(kata). The Dar es Salaam region is divided into three districts: Kinondoni,
Ilala, and Temeke, which is the largest of the three districts. It has an
area of 407 square miles and, as of 2007, a population of 886,529. ...

3. Commanding Heights and Failed Promises

In August 2000, the political atmosphere in the village was tense. Rival
party leaders and representatives were making political speeches in a large
open space close to the marketplace late into the evening hours. The two
rival political parties were the CCM and the CUF. Tanzania, which was
until recently a one-party socialist state,1 ...

Part II: Local Practices

4. Micropolitics of Childhood Malaria

One early afternoon in April 2001, on my way to Kimbangulile, a small
hamlet that sits on the top of one of the hills surrounding Mbande village,
I recognized Zaituni, a woman in her mid-forties, as she was coming down
the slopes of one of the hills. Two weeks earlier, I had engaged in an informal
conversation with Zaituni at the dispensary in Mbande, ...

5. Malaria Deaths and Meaning Making

Mwanzani, a forty-four-year old woman was desperately trying to revive
her dying two-year-old daughter, Salama. Mzee Tinyango, the local
mganga, had diagnosed Salama with degedege. Salama succumbed to
her illness and died later that afternoon. The child’s father, Mzee Omary,
along with others who had arrived to mourn her death, ...

6. Malaria, Single Mothers, and Social Suffering

One late afternoon in July 2005, I was sitting on the threshold of a large
Swahili house,1 along with Mama Afidhi, my field assistant, watching a
mason putting some final additions to the exterior of a new concrete house
that was about fifty feet away from where we were seated. ...

Part III: Philanthrocapitalism

7. Old Ideas and New Promises

Hadija, a thirty-five-year-old mother of four children, was visibly distraught
when she arrived at my house in Mbande for a prearranged interview. I had
previously interviewed Hadija in December 2005, regarding her youngest
child who was diagnosed with malaria and treated with sulfadoxine-pyrimethamine. ...

8. Pharmaceutical Nexus and Globalizing Antimalarials

As with all pharmaceuticals, antimalarials have social lives. They are produced,
marketed, prescribed, distributed through formal and informal
channels, meet their death through one or another form of consumption,
and have lives after death in the form of efficacy in modifying bodies
(Whyte et al. 2002:13–14; ...

Part IV: The Way Forward

9. Conclusion: From Malaria Control to Malaria Elimination

This book was not written as a policy prescription for malaria control
or malaria elimination but as an anthropological critique of the shifting
global discourses and practices on malaria. On the basis of insights
developed during my ethnographic research in Tanzania, I have argued
that global efforts to deal with malaria have become overzealously hegemonic, ...

10. Epilogue: The End of Malaria?

On June 25, 2011, I visited Mbande along with three graduate students
from North America and the U.K. who had read my work and wanted to
see it for themselves. Prior to this visit, I had decided that this would be
my last research-related visit to the village because I had initiated fieldwork
on food security in the Mtwara region on the Tanzania-Mozambique
border. ...

Glossary of Kiswahili Terms

Notes

References

Index

About the Author

Vinay Kamat received his PhD in social work from the Tata Institute of
Social Sciences in Bombay, India, in 1992 and his PhD in anthropology
from Emory University in 2004. He had been an assistant professor of
anthropology at the University of British Columbia since 2003 and in
2010 was promoted to associate professor. ...

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